Pancreaticoduodenectomy. University experience and resident education
R. J. Doerr, I. Yildiz and L. M. Flint
Department of Surgery, School of Medicine and Biomedical Sciences, State University of New York, Buffalo.
A radical pancreaticoduodenectomy offers the best chance for survival in
patients with periampullary and pancreatic malignant neoplasms. A
pancreaticoduodenectomy has educational value since complex pancreatic
operations are demanding and important to the training of surgical
residents. Increased pancreaticoduodenectomy experience (per surgeon) has
been associated with improved outcomes. We examined the hypothesis that
residents who are supervised by faculty surgeons can perform
pancreaticoduodenectomies with acceptable outcomes. From 1976 to 1987, 127
pancreatic resections were performed by 81 residents who were supervised by
15 faculty surgeons in four teaching hospitals. A pancreaticoduodenectomy
was performed on 61 patients. All residents served as an operating surgeon
on a pancreatic resection, and 58 (82%) performed
pancreaticoduodenectomies. The mortality for the pancreaticoduodenectomies
was 8%, with a 36% major complication rate. A pancreaticoduodenectomy can
be performed safely by residents under supervision. A review of the results
identifies the means of improving outcomes. These results justify the
preservation of a pancreaticoduodenectomy as an important experience for
residents.
